Sadoul Jean-Louis
CHU de Nice, hôpital de l'Archet, service d'endocrinologie-diabétologie-reproduction, BP 3079, 06202 Nice, France.
Presse Med. 2011 Dec;40(12 Pt 1):1163-73. doi: 10.1016/j.lpm.2011.10.002. Epub 2011 Nov 25.
Thyroid ophthalmopathy is one of the features of auto-immune thyroid diseases. Exophtalmos is not the only sign of this affection and may even be absent in severe sight-threatening cases. All subjects with this ophtalmopathy should benefit from euthyroidism restoration, smoking withdrawal and local measures. Objective and repeated assessment should identify the mild and stable disease carrying a fair prognosis and therefore recognize without delay the other patients for whom an optimal management will be supported by a multidisciplinary and expert team. The treatment of choice for moderate-to-severe and active ophthalmopathy is intravenous glucocorticoids. Sight-threatening cases not rapidly alleviated by intravenous glucocorticoids warrant surgical decompression. Later on, surgery (orbital decompression, squint surgery, eyelid surgery, in this order) will eventually be needed for inactive disease.
甲状腺眼病是自身免疫性甲状腺疾病的特征之一。眼球突出并非这种病症的唯一体征,在严重威胁视力的病例中甚至可能不存在。所有患有这种眼病的患者都应从甲状腺功能正常的恢复、戒烟和局部治疗措施中获益。客观且反复的评估应识别出预后良好的轻度和稳定疾病,从而及时识别出其他需要多学科专家团队提供最佳治疗的患者。中重度活动性眼病的首选治疗方法是静脉注射糖皮质激素。静脉注射糖皮质激素不能迅速缓解的威胁视力的病例需要进行手术减压。对于非活动性疾病,最终可能需要依次进行手术(眼眶减压、斜视手术、眼睑手术)。